学历因素影响帕金森病脑深部电刺激术后焦虑和抑郁改善的研究

摘要

目的 研究影响帕金森病患者脑深部电刺激( DBS)术后焦虑和抑郁改善的相关因素;包括学历水平、运动症状改善率等.方法 北京天坛医院功能神经外科收治的90例帕金森病行DBS术患者.所有患者采用单侧或双侧DBS术进行治疗,术后1个月打开刺激器.分别于术前和术后1个月、3个月对患者进行评估和随访,内容包括患者基本资料、用药情况、量表评分.根据患者的汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分变化,评估患者焦虑和抑郁症状的改善程度;采用相关分析法分析影响DBS术后焦虑和抑郁改善的因素.结果 本组患者DBS术后的焦虑和抑郁症状均明显改善(均P＜0.05).大学学历组患者术后的焦虑症状明显改善(P＜0.05),大学以下学历患者术后的焦虑症状明显改善(P＜0.05).大学学历组患者术后与术前的抑郁量表评分比较,差异无统计学意义;大学以下学历组患者术后抑郁症状改善明显(P＜0.05).大学学历组患者术后的焦虑改善率与运动改善率呈正相关(r2 ＝0.35,P＜0.05),大学以下学历组患者术后的焦虑改善率与运动改善率呈负相关趋势(r2 ＝0.08,P＝0.09);大学学历组患者术后的抑郁改善率与运动改善率呈正相关趋势(r2 ＝0.11,P＝0.26),大学以下学历组患者术后的抑郁改善率与运动改善率呈负相关趋势(r2 ＝0.06,P＝0.13).结论 DBS术后患者的焦虑、抑郁评分明显降低;大学学历患者术后的焦虑症状明显改善,大学以下学历患者术后焦虑、抑郁症状均明显改善.大学学历患者的焦虑、抑郁改善率与运动改善率呈正相关趋势,大学以下学历患者的焦虑、抑郁改善率与运动改善率呈负相关趋势.%Objective To analyze the related factors which can affect the improvement of anxiety and depression symptoms after deep brain stimulation operation , including education level , amelioration about the rate of motor symptoms , etc.Methods This study included 90 patients with Parkinson’s disease(PD) undergoing STN-DBS.All patients were treated with unilateral or bilateral deep brain electrode implantation , and the stimulator was opened one month after operation.The patients were evaluated , including the basic information , levodopa equivalent daily dose ( LEDD), and scale assessment preoperatively , at 1 month follow-up and 3 months follow-up.The improvement of anxiety and depression symptoms were estimated according to the changes of the scores of Hamilton anxiety scale ( HAMA ) and Hamilton depression scale ( HAMD ).Then, correlation analysis were used to study the possible factors that could affect the improvement of anxiety and depression postoperatively.Results The symptoms of anxiety and depression were significant improved at 3 months follow-up ( all P＜0.05).Postoperative anxiety symptoms were significantly improved in the college-educated group(P＜0.05), and the similar improvement was also observed in the under college-educated group ( P ＜0.05 ).In the college-educated group, there was no significant difference between preoperative and postoperative HAMD scores , but the postoperative symptoms of depression improved significantly in the under college-educated group ( P ＜0.05 ). There was a positive correlation between the rate of anxiety improvement and the rate of movement improvement in the college-degree group ( P ＜0.05, r2 ＝0.35 ).A negative correlation trend between the rate of anxiety improvement and the rate of movement improvement were observed in the under college-degree group ( P ＝0.09, r2 ＝0.08 ).A positive correlation trend was observed between postoperative depression improvement rate and movement improvement rate in the college group( P＝0.26,r2 ＝0.11), and a negative correlation trend could be found between postoperative depression improvement rate and movement improvement rate in the college group ( P＝0.13,r2 ＝0.06).Conclusions The scores of HAMA and HAMD of the patients undergoing DBS operation are significantly decreased.In the college-degree group, there is a positive correlation trend between the improvement of anxiety and depression and the movement improvement rate.In the under college-degree group, there is a negative correlation trend between the improvement of anxiety and depression and the movement improvement rate.